Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Tuesday, December 08, 2009

Troubled £12bn NHS IT System to be Scaled Back: UK MP's Come to Their Senses on Health IT. Will the U.S. Follow?

The UK National Programme for Health IT in the NHS, by the findings of the House of Commons Public Account audit committee, has been a £12bn debacle. Started as a starry-eyed utopian fantasy about experimental computerized clinical tools by former Prime Minister Tony Blair, nearly every possible mistake outlined at my ten year old website on HIT failure has been made, and made in abundance, the coup de grâce being dependence on an American health IT company.

It seems people's ability to detect rigor and seriousness in industrialists has become seriously impaired, the recent spectacular Ponzi schemes fallen for by quite prominent people and foundations being one example. Now the UK is at the point where hospitals are "unable to share documents" relating to problematic EHR's as their contract with that vendor includes a confidentiality clause. (Not that such clauses are limited to one company.

The health IT industry has generally profited from a sweetheart relationship of stunning proportions with healthcare regulatory agencies (it is entirely unregulated); with government (in the U.S., hundreds of billions of dollars are being thrown their way on similar starry-eyed dreams about reduced costs and improved quality per the economic "stimulus" bill); and with healthcare organizations (who accept HIT marketing puffery hook, line and sinker, do not perform due diligence properly for such critical clinical tools, who manage IT and informatics talent poorly, and who willingly sign defects nondisclosure and hold harmless clauses that violate the fiduciary responsibilities of their governance bodies as in my JAMA letter here and longer essay here).

At least for the £12bn down the drain, the U.K. is coming to their senses:

The government is to scale back its £12bn NHS IT system in what the Tories are calling a "massive U-turn".

Chancellor Alistair Darling said he would be delaying parts of the scheme in Wednesday's pre-Budget Report as it was "not essential to the front line".

The move may save hundreds of millions but Mr Darling admitted it was only a fraction of total spending cuts needed.

The Tories and Lib Dems have been calling for the IT system, which has been hit by costly delays, to be axed.

... “It has held back the development of IT at a local level, cost billions and is running years behind schedule” - Norman Lamb, MP Liberal Democrats.

... [Chancellor Darling] said the full picture of cuts would not emerge until "the first half of next year at some point" - a reference to the comprehensive spending review, which the government has delayed until after an election.

The comprehensive spending review should be interesting, to say the least. I humbly suggest the NHS look at the contracting practices of the vendors, especially the gag clauses, the multiply-layered subcontracting deals with dyscompetent consulting companies common in IT, and conflicts of interest of local and national program leaders with IT and consulting suppliers.

I also suggest the reviewers borrow from the U.S. Senate Committee on Finance letter here from Senator Grassley to HIT vendors and consultants.

'Procurement disaster'

Treasury officials have stressed that only part of the NHS IT programme is facing the axe, and the whole project will not be scrapped.

But the Conservatives said Mr Darling's words represented a "massive U-turn".

Shadow Health Secretary Andrew Lansley said it was "another government IT procurement disaster".

"After seven years Labour have finally acknowledged what we've said for years, that the procurement for NHS IT was costing billions and not delivering," he said.

Why did it take years to acknowledge the obvious? The driving force behind blindness to IT failure goes way beyond wishful thinking. Lack of knowledge by the leadership of the complexities of "doing health IT right" and the ease of getting it wrong are a factor, especially when employing management talent in top positions inappropriate to the job such as these:

The Department of Health has announced the two long-awaited senior management appointments for the National Programme for IT ... The Department announced in February that it was recruiting the two positions as part of a revised governance structure for handling informatics in the Department of Health.

Christine Connelly will be the first Chief Information Officer for Health and will focus on developing and delivering the Department's overall information strategy and integrating leadership across the NHS and associated bodies including NHS Connecting for Health and the NHS Information Centre for Health and Social Care.Christine Connelly was previously Chief Information Officer at Cadbury Schweppes with direct control of all IT operations and projects. She also spent over 20 years at BP where her roles included Chief of Staff for Gas, Power and Renewables, and Head of IT for both the upstream and downstream business.

Martin Bellamy will be the Director of Programme and System Delivery. He will lead NHS Connecting for Health and focus on enhancing partnerships with and within the NHS.Martin Bellamy has worked for the Department for Work and Pensions since 2003. His main role has been as CIO of the Pension Service.

"Informatics leadership" in healthcare with these backgrounds? Where's Winston Churchill when you need him?

Large sums of money in one's pocket also creates the most rabid enthusiasm in face of the obvious.

The electronic patient record system, which is thought to have cost about £12bn so far, was commissioned in 2002 by then prime minister Tony Blair, and was meant to be completed by 2010.

This sounds eerily familiar to the U.S., which set an equally unrealistic ten year timeline for a major social re-engineering project -- entirely dependent on experimental IT -- of immense proportions.

Mr Lansley told BBC One's Politics Show the Tories would scrap the "enormous centralised IT system" and instead give hospitals "the opportunity to buy IT systems" that could transfer images, patient records and prescriptions electronically.

A focus on easy wins - providing local hospitals leeway to buy or build systems to transfer images, basic records useful to clinicians in the real world (as opposed to every data point in the known universe possible about a patient) and prescriptions, with incremental refinement and slow spread as IT and human capabilities warrant, should have been the focus at the start, not an idealistic project to create a centralized national Medi-net.

It comes as the Conservatives called for a moratorium on all government computer projects, ahead of the publication of the government's five-year IT strategy later this week. They say Labour has spent £100bn on IT since 1997 and contracts worth another £70bn are due to be renewed or commissioned in the next two years.

That's a lot of money. What's the ROI, exactly?

The Liberal Democrats said the NHS programme had been "flawed from the start".

The party's health spokesman, Norman Lamb, said: "It has held back the development of IT at a local level, cost billions and is running years behind schedule."

That is subtantiated by the above linked House of Commons report.

But Dr Grant Ingrams, from the British Medical Association, said the system currently scheduled to come into effect would result in the NHS saving money.

"It's an essential tool for clinicians, for doctors and other staff to be able to treat patients," he said.

"The NHS pays out a third of a billion pounds a year on mistakes; a lot of that could be put right if the IT was in place."

That type of statement about medical mistakes is at the crux of the idealists' and zealots' dream. Unfortunately, they do not ask these simple minded questions:

Are those mistakes due to informational issues, e.g., lack of immediate availability of patient information, or due to other personal, local and/or systemic factors?

What percentage of the mistakes meet the criterion of being amenable to "prevention by IT"?

Could computerized systems create new mistakes of their own?

Where is the robust evidence that supports such a statement about error prevention?

Has such evidence been rigorously reconciled with an accumulating evidence base to the contrary?

The answers to these simple questions are not hard to obtain to anyone who cares to look, and who will take off their global warming "Hide the Decline" blinders (warning: YouTube link to a most apropos satire and mockery).

Lacking the miracle of our own government officials sprouting new brain cells in cortical centers responsible for critical thinking and ethics, I regrettably predict the U.S. will be at this same point in approximately three to five years.

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